Representation of adverse childhood experiences is associated with lower public stigma towards people who use drugs: an exploratory experimental study

By Harry R. Sumnall, Ian Hamilton, Amanda M. Atkinson, Catharine Montgomery and Suzanne H. Gage - Drugs: Education, Prevention, and Policy

Public stigma refers to attitudes and behaviours toward individuals of particular social groups, often a minority, who possess or are perceived to possess a characteristic that is contrary to a social norm. This can lead to devaluing of the characteristic, endorsement of stereotypes and labelling, and social status loss of the target group. Internalised stigma, resulting from individual experiences or anticipation of enacted public stigma, can present barriers to personal, economic, and healthy development, and when endorsed are important sources of health and social inequity.

Substance use is an example of a social behaviour that is differentially valued or devalued depending upon whether it conforms with socially approved patterns of use and norms (including which substance is used and how it is used), and intersection with other characteristics such as gender, ethnicity, religion, health status, deprivation, and social class. In accordance with socio-ecological models, stigmatising public attitudes are reinforced by (drug) policy, laws, societal structures, and the media, and may be reproduced through the practices of some institutions and professionals. This can undermine provision, access, and the quality of drug treatment, and may reinforce discrimination and broader health and social inequity. People who use drugs (PWUD), including those in receipt of treatment, report that perceptions and experiences of public and internalised stigma can lead to reduced self-worth and label avoidance, and act as a barrier to treatment seeking and recovery.

This is of particular importance because problem substance use is associated with significant disease burden, and early treatment entry is protective against morbidity and mortality. Stigma may also have adverse effects beyond clinical outcomes, leading to differential public and political support for health policies and criminal justice response preferences; barriers to employment; reduced housing and social support; and increased social distance with other community members.

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